Advances in External Beam Radiotherapy Across Malignancies: Evidence, Technology, and Clinical Outcomes

External beam radiotherapy (EBRT) is a cornerstone of cancer treatment, with ongoing advances in imaging, motion management, planning automation, and adaptive workflows reshaping its delivery and impact. Recent technological developments- such as image-guided, stereotactic, and adaptive techniques- have dramatically improved targeting precision, enabling safer dose escalation and more efficient sparing of healthy tissue. At the same time, innovations in data-driven planning, including knowledge-based and deep-learning approaches, are enhancing quality assurance and plan consistency across centers. Despite these advances, translation of technical progress into consistent improvements in patient-centered outcomes remains uneven across malignancies, largely due to fragmented evidence, heterogeneous clinical practices, and limited standardization in integrating new technologies with evolving systemic therapies.The field now faces pressing questions about how best to implement and scale these innovations to maximize benefit for diverse patient populations. Clinical data remain compartmentalized by disease site, trial methodology, or reporting conventions, and the optimal criteria for selecting dose, fractionation, motion management, and adaptive strategies often lack consensus. As EBRT is increasingly combined with immunotherapies and targeted agents - and reconsidered for complex cases such as oligometastatic/progressive disease and re-irradiation- clarity is also needed around issues like sequencing, radiosensitization, toxicity mitigation, and equitable access. Latest studies highlight progress in translational biomarkers, automated planning, and prospective multisite quality assurance, yet practical guidance is still evolving on standardizing these approaches for real-world implementation.This Research Topic aims to bridge the gap between rapid EBRT innovation and clinically meaningful, reproducible improvements in outcomes. Emphasizing rigorous clinical and translational research, this Topic seeks studies that define best practices for integrating advanced technology into standard workflows, clarify indications for stereotactic and adaptive radiotherapy, and advance biomarker-guided personalization. By consolidating transparent methodologies and clinically relevant endpoints - spanning local control, survival, organ preservation, toxicity, and patient-reported outcomes - we will generate actionable knowledge that supports equitable, scalable implementation across diverse settings.To gather further insights into the implementation and value of modern EBRT, this Research Topic welcomes articles that prioritize clinically meaningful endpoints, innovative methodologies, and transparent reporting. Areas of focus include, but are not limited to:- Imaging and physics innovations: IGRT, MR-guided and 4D workflows, online/adaptive radiotherapy, dose painting, motion management.- Treatment planning and quality assurance: knowledge-based and deep-learning planning, process automation, independent dose checks, and automated QA.- Clinical effectiveness: disease-specific studies (head and neck, thoracic, gastrointestinal/hepatobiliary, genitourinary/prostate, CNS/spinal), re-irradiation, oligometastatic/oligoprogressive disease, palliative endpoints.- Combination therapies: integrating EBRT with immunotherapy, targeted agents, chemotherapy; sequencing, radiosensitization, toxicity reduction.- Biomarkers and prediction: systemic and nutritional indices, body composition, genomics, radiomics, AI-based risk assessment.- Patient-centered outcomes and value: patient-reported outcomes, survivorship, late effects, geriatric considerations, cost-effectiveness, and strategies to address access and equity.Please note that manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases that are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of the scope of this Research Topic.Dr. Khaled Elsayad is affiliated with BHW GmbH (Germany).Dr. Atsuto Katano and Dr. Oliver Micke declared no conflicts of interest. Topic editors: Khaled Elsayad, Oliver Micke, Atsuto Katano Source: https://www.frontiersin.org/research-topics/77098/advances-in-external-beam-radiotherapy-across-malignancies-evidence-technology-and-clinical-outcomes